不能手术的慢性血栓栓塞性肺动脉高压球囊肺血管成形术的并发症:对结果的影响

2022-06-28 网络 网络

球囊肺血管成形术(BPA) 是一种新兴的介入治疗,用于治疗无法手术的慢性血栓栓塞性肺动脉高压(CTEPH),其靶向肺动脉的亚段分支。本研究的目的是评估某些并发症对治疗后结果的影响。

球囊肺血管成形术 (BPA) 是一种用于无法手术的慢性血栓栓塞性肺动脉高压 (CTEPH) 患者的介入治疗方式。支持 BPA 治疗的证据越来越多,但由于缺乏长期数据, 目前的指南并不强烈推荐 BPA。尽管有良好的血流动力学和功能结果,但 BPA 的高并发症发生率已发表。主要问题是肺损伤的发生。然而,对这种情况的理解随着时间的推移而发生了变化:在使用 BPA 的最初几年,肺损伤被解释为再灌注损伤,在 CTEPH 的手术治疗中也观察到了这种情况。最近,金属丝穿孔伴实质出血被认为是肺损伤的主要原因。大多数执行 BPA 的中心都经历了高并发症率和陡峭的学习曲线,9% 至 61% 的患者被描述为肺损伤。死亡率在 0% 和 5.6% 之间变化。并发症和死亡率以及结果正在改善,这取决于中心的专业知识。某些病变类型—例如,环状狭窄、蹼、次全或完全闭塞以及曲折病变—已被描述为与不同的肺损伤率相关。然而,并发症的发生是否会导致更糟糕的结果仍不清楚。因此,本研究的目的是分析因无法手术的 CTEPH 而接受 BPA 的具有某些并发症的患者的结果。此外,基线参数被评估为预测并发症和结果的指标。

研究方法:

从 2014 年 3 月到 2019 年 12 月,共有 235 名不能手术的 CTEPH 患者接受了 BPA。在这些患者中,有 140 名在最后一次干预后 6 个月完成了随访检查;另有 2 名患者因 BPA 并发症死亡。

研究结果:

较高的基线肺血管阻力(PVR) >6.6 WU 与较高的并发症发生率(主要是肺动脉穿孔)相关。BPA 期间的金属丝穿孔与 PVR 减少方面的较差结果无关。在研究的 5 年期间,每次干预的并发症发生率从 21% 下降到 14%。

研究结论:

在本研究中,我们检查了 BPA 对无法手术的 CTEPH 患者的影响和并发症发生率。本研究的主要发现是:(1)较高的基线 PVR(> 6.6 WU)与较高的并发症发生率(主要是肺动脉穿孔)相关;(2) 没有其他检查的患者特征可以预测并发症;(3)肺动脉穿孔的发生不影响PVR降低的有益效果。BPA 中经常遇到并发症。然而,绝大多数并发症在处理得当时不会引起任何重大问题,并且在经验丰富的中心死亡率有所下降。并发症的发生不会使结果恶化,因此不是早期停止介入治疗的原因。

 

参考文献:

Wiedenroth CB, Deissner H, Adameit MSD, Kriechbaum SD, Ghofrani HA, Breithecker A, Haas M, Roller F, Rolf A, Hamm CW, Mayer E, Guth S, Liebetrau C. Complications of balloon pulmonary angioplasty for inoperable chronic thromboembolic pulmonary hypertension: Impact on the outcome. J Heart Lung Transplant. 2022 May 20:S1053-2498(22)01944-1. doi: 10.1016/j.healun.2022.05.002. Epub ahead of print. PMID: 35690560.

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    2022-11-25 丁鹏鹏
  5. [GetPortalCommentsPageByObjectIdResponse(id=2004762, encodeId=d2ad2004e62b4, content=<a href='/topic/show?id=4e8a5400816' target=_blank style='color:#2F92EE;'>#成形术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54008, encryptionId=4e8a5400816, topicName=成形术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7fb6449, createdName=ZGMFX24A, createdTime=Thu May 25 02:44:48 CST 2023, time=2023-05-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1925621, encodeId=96d11925621eb, content=<a href='/topic/show?id=26d633354c9' target=_blank style='color:#2F92EE;'>#动脉高压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33354, encryptionId=26d633354c9, topicName=动脉高压)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Sun Jan 29 21:44:48 CST 2023, time=2023-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1990147, encodeId=0de3199014e68, content=<a href='/topic/show?id=66308965e00' target=_blank style='color:#2F92EE;'>#血管成形术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89657, encryptionId=66308965e00, topicName=血管成形术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f5b299, createdName=xuyu, createdTime=Thu Aug 25 17:44:48 CST 2022, time=2022-08-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1758449, encodeId=e7551e584496e, content=<a href='/topic/show?id=84ba49031f9' target=_blank style='color:#2F92EE;'>#并发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49031, encryptionId=84ba49031f9, topicName=并发)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a27e37327108, createdName=丁鹏鹏, createdTime=Fri Nov 25 17:44:48 CST 2022, time=2022-11-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1227189, encodeId=6808122e1890f, content=好文章,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJlfgys76DEiaNtbYo2re3ibjrUPTRibEXRyFwAB4aAGiave842S0FQDf0wAoaH226NiaSoPPDzhndsf1g/132, createdBy=88b489038, createdName=yangchou, createdTime=Sat Jun 18 11:37:50 CST 2022, time=2022-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1384447, encodeId=8b89138444eff, content=<a href='/topic/show?id=2e956863556' target=_blank style='color:#2F92EE;'>#球囊#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68635, encryptionId=2e956863556, topicName=球囊)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0361487, createdName=花花1366, createdTime=Thu Jun 16 08:44:48 CST 2022, time=2022-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1407454, encodeId=45a0140e454c3, content=<a href='/topic/show?id=f81a6865123' target=_blank style='color:#2F92EE;'>#球囊肺血管成形术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68651, encryptionId=f81a6865123, topicName=球囊肺血管成形术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b4f42649793, createdName=july_976, createdTime=Thu Jun 16 08:44:48 CST 2022, time=2022-06-16, status=1, ipAttribution=)]
    2022-06-18 yangchou

    好文章,谢谢分享。

    0

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    2022-06-16 花花1366
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